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NPI Code Detail

MEDICARE: STATEN ISLAND OPHTHALMOLOGY, PC

MEDICARE: STATEN ISLAND OPHTHALMOLOGY, PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207W00000XOphthalmology Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1W4V841OTHERNYMEDICARE PTAN

General Provider Information

NPI Number : 1578570198
Entity Type Code : Organization
Provider Name (Legal Business Name) : STATEN ISLAND OPHTHALMOLOGY, PC
Provider Business Mailing Address
First Line : 23 OCEANIC AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10312-6511
Country : US
Telephone Number : 718-948-8880
Fax Number : 718-967-6040
Provider Business Practice Location Address
First Line : 23 OCEANIC AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10312-6511
Country : US
Telephone Number : 718-948-8880
Fax Number : 718-967-6040
Authorized Official
Title or Position : OWNER
Name : JOHN S KUNG
Credential : M.D.
Telephone Number : 718-948-8880
Provider Enumeration Date : 08/03/2006
Last Update Date : 01/08/2024

Similar Medicare Providers

1003923509 — DR. JANNA CHEN O.D.
Practice Location Address:
23 OCEANIC AVE
STATEN ISLAND, NY
10312-6511
Practice Phone: 718-948-8880
Practice Fax:
1184726291 — DANIEL ARNOLDI O.D.
Practice Location Address:
23 OCEANIC AVE
STATEN ISLAND, NY
10312-6511
Practice Phone: 718-948-8880
Practice Fax: 718-967-6040
1497857080 — DR. JOHN S KUNG M.D.
Practice Location Address:
23 OCEANIC AVE
STATEN ISLAND, NY
10312-6511
Practice Phone: 718-648-8880
Practice Fax: 718-967-6040
1235394842 — DR. CHUNG CHI YU M.D.
Practice Location Address:
23 OCEANIC AVE
STATEN ISLAND, NY
10312-6511
Practice Phone: 718-948-8880
Practice Fax: 718-967-6040
1518537331 — DR. RYAN JAMES CAMPBELL OD
Practice Location Address:
23 OCEANIC AVE
STATEN ISLAND, NY
10312-6511
Practice Phone: 718-948-8880
Practice Fax:
1972234649 — MS. JACLYN MISTRETTA LCSW
Practice Location Address:
37 OCEANIC AVE
STATEN ISLAND, NY
10312-6511
Practice Phone: 917-622-0114
Practice Fax:

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